What is your diagnosis?

Medial epicondyle avulsion fracture [1]. 

In patients with a history of little league elbow, the incidence of medial epicondyle pathology increases with poor throwing mechanics, excessive pitch counts, and attempting to throw harder and longer distances. With avulsion fractures, patients report a "pop", point tenderness, swelling, and decreased range of motion. Diagnosis is made by plain films or MRI. [1,2,3]

• Pearl: Injury may have ulnar nerve involvement, therefore thorough neurologic evaluation is essential. [1,3].
• Pearl: Medial epicondyle avulsion fracture is associated with medial joint instability due to the origin of the ulnar collateral ligament and flexor-pronator mass [1,2,3]. Additionally, patients may present with a flexion contracture – seen in inability to fully extend the elbow. Incarceration of the fragment may occur in 30-50% of these injuries [1]. 

What is your management in the ED?

Minimally displaced fractures may be treated with immobilization; while fractures with > 5 mm displacement in the setting of joint laxity indicated the need for surgical intervention. Posterior long arm splint with or without forearm sugar-tong depending on laxity at the medial elbow or joint instability.

What is your disposition? Do you consult orthopedics emergently?

Discharge home with urgent follow up in Orthopedic clinic. However, if there is evidence of ulnar nerve involvement, Orthopedic Surgery should be consulted emergently.